- Medical Mutual of Ohio (OH)
- …with RN experience, DRG,_** **_and/or_** **_hospital bill auditing experience._** **Responsibilities** ** Medicare Clinical Auditor ** + **Audits outpatient, ... payment recovery staff.** + **Performs other duties as assigned.** **Senior Medicare Clinical Auditor ** + **Audits outpatient, inpatient and professional… more
- UCLA Health (Los Angeles, CA)
- …As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor , you will be an expert in risk adjustment coding and documentation, working ... or more years of experience in providing education to clinical and non- clinical staff, required + Six...(II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications, required… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- Summary With direction from the Patient Financial Services Director, the Nurse Auditor / Revenue Integrity/ CDM Analyst is responsible for performing audits of ... the billing staff of appropriate HCPCS codes and modifiers. The Nurse Auditor / Revenue Integrity/ CDM Analyst works directly with revenue producing departments… more
- Hackensack Meridian Health (Hackensack, NJ)
- …serve as a leader of positive change. The **Diagnosis Related Group (DRG) Auditor ** is responsible for auditing clinical documentation that supports code ... includes compliance with the Conditions of Participation for CMS. The DRG auditor is responsible for ensuring coding accuracy, coding consistency and efficiency in… more
- Johns Hopkins University (Baltimore, MD)
- We are seeking a **Sr. Compliance Auditor ** **Trainer** who will provide on-going training and support to physicians, non-physician providers, professional fee ... medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the clinical departments,… more
- HCA Healthcare (Nashville, TN)
- …Nurse Auditor evaluates medical record documentation for evidence of clinical information to support charges, observation hours, status orders, charge orders ... hours volunteering in our communities. As a Revenue Integrity Auditor RN with Parallon you can be a part...to obtain missing documentation when applicable. Ability to associate clinical and coding information to national and local coverage… more
- Henry Ford Health System (Troy, MI)
- …review, presentation of staff education and other related activities. The RI Auditor coordinates processes between clinical operations and revenue cycle ... Reporting to the Manager, Revenue Integrity, the Revenue Integrity Auditor must have a comprehensive understanding of medical terminology, coding, charge entry, and… more
- State of Colorado (Denver, CO)
- …II- Quality Assurance Policy Specialist/ Auditor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4713263) Apply Health Professional ... II- Quality Assurance Policy Specialist/ Auditor Salary $57,564.00 - $80,592.00 Annually Location Denver, CO Job Type Full Time Job Number IIB 06255 11/01/2024… more
- AdventHealth (Altamonte Springs, FL)
- …you'll contribute:** The inpatient or outpatient coding team Corporate Quality Auditor (QA)/Educator supports the operations of the inpatient or outpatient coding ... to achieve industry best practice levels of performance. The Corporate Quality Auditor will adhere to AdventHealth Corporate Compliance standards, as well as rules… more
- Fallon Health (Worcester, MA)
- …the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …the general nature, level and purpose of the job. The Senior Charge Capture Auditor works closely with clinical departments to ensure compliance with government, ... payer, and internal charge capture policies; provides education to the clinical departments. This position works with Med Assets software to manage clinical … more
- Covenant Health Inc. (Knoxville, TN)
- …CPC, or CPMA. Apply/Share Job Title CODING AUDITOR -EDU-CLINIC ID 4106253 Facility Covenant Medical Management Department Name Clinical Doc Integty ... of CPT coding, modifiers and billing processes to ensure compliance with Medicare , Medicaid guidelines and other insurance payers and to maximize reimbursement. +… more
- Sharp HealthCare (San Diego, CA)
- …coder. + 2 Years experience working as a HCC risk adjustment coding auditor . + Experience with medical billing and with medical terminology. + Certified Professional ... of care following coding rules and regulations.Applies understanding of Medicare , Medi-Cal and other payor guidelines.Identifies documentation deficiencies and… more
- Rising Medical Solutions (Chicago, IL)
- …born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. Join ... neuro, rehab, or ER procedures + 3-5 years of clinical experience in acute care, surgery and/or orthopedic +...plus + Understanding of CPT and ICD-10 codes and Medicare guidelines + Ability to apply knowledge to state… more
- Northwell Health (Garden City, NY)
- …a HCS-D - Home Care Coding Specialist-Diagnosis, COS-C Certificate for OASIS Specialist- Clinical . Conducts Home Health Resource Group (HHRG) Validation to ensure the ... the documentation in the Medical Record. Job Responsibility + Audits and reviews Medicare /non- Medicare charts to ensure that proper standards are maintained in… more
- Northwell Health (Port Jefferson, NY)
- …by the documentation in the Medical Record. Job Responsibility 1.Leverages clinical expertise to identify and validate DRG code assignment. 2.Full review ... and principals; performs coding audits for optimization. 4.Audits and reviews Medicare /non- Medicare charts to ensure that proper standards are maintained… more
- Intermountain Health (Murray, UT)
- …effective and consistent manner; aligned with regulatory guidelines (Centers for Medicare and Medicaid Services [CMS], federal and state [Accountable Care ... effective and consistent manner; aligned with regulatory guidelines (Centers for Medicare and Medicaid Services [CMS], federal and state [Accountable Care… more
- Atlantic Health System (Morristown, NJ)
- …assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of ... testing records for physician practices. 2. Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact… more
- Johns Hopkins University (Baltimore, MD)
- …care vs research costs for participation in clinical trials and clinical research studies based on Medicare National Coverage Determinations (NCDs), ... be responsible for performing a comprehensive Prospective Reimbursement Analysis. The Clinical Research Coverage Analyst is responsible for reviewing clinical … more
- Commonwealth Care Alliance (Boston, MA)
- …Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement edits and necessary coding configuration requirements ... This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for… more